Abstract
Background: In 2011, Oregon implemented a policy that reduced the state's rate of early (before 39 weeks' gestation) elective (without medical need) births. Objective: This analysis measured differential policy effects by race, examining whether Oregon's policy was associated with changes in non-Hispanic Black–White disparities in early elective cesarean and labor induction. Methods: We used Oregon birth certificate data, defining prepolicy (2008–2010) and postpolicy (2012–2014) periods, including non-Hispanic Black and White women who gave birth during these periods (n = 121,272). We used longitudinal spline models to assess policy impacts by race and probability models to measure policy-associated changes in Black–White disparities. Results: We found that the prepolicy Black–White differences in early elective cesarean (6.1% vs. 4.3%) were eliminated after policy implementation (2.8% vs. 2.5%); adjusted models show decreases in the odds of elective early cesarean among Black women after the policy change (adjusted odds ratio, 0.47; 95% confidence interval, 0.22–1.00; p =.050) and among White women (adjusted odds ratio, 0.79; 95% confidence interval, 0.67–0.93; p =.006). Adjusted probability models indicated that policy implementation resulted in a 1.75-percentage point narrowing (p =.011) in the Black–White disparity in early elective cesarean. Early elective induction also decreased, from 4.9% and 4.7% for non-Hispanic Black and non-Hispanic White women to 3.8% and 2.5%, respectively; the policy was not associated with a statistically significant change in disparities. Conclusions: A statewide policy reduced racial disparities in early elective cesarean, but not early elective induction. Attention to differential policy effects by race may reveal changes in disparities, even when that is not the intended focus of the policy.
Original language | English (US) |
---|---|
Pages (from-to) | 224-231 |
Number of pages | 8 |
Journal | Women's Health Issues |
Volume | 28 |
Issue number | 3 |
DOIs | |
State | Published - May 1 2018 |
Bibliographical note
Funding Information:Funding Statement: Supported by funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (grant number R00 HD079658-03), the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number R40 MC26809-01-00, and a Jr. Investigator Award from the Society of Family Planning (SFPRF9-JI2). The funding organizations had no role in design or conduct of the study; collection, management, analysis, or interpretation of the data; and preparation, review, or approval of the manuscript.
Publisher Copyright:
© 2017 Jacobs Institute of Women's Health